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Daily Checkup: Depresssion’s huge reach


Sunday, December 6, 2015, 2:00 AM

Dr. James Murrough directs the Mood and Anxiety Disorders Program at Mount Sinai.

The Specialist:

As the director of the Mood and Anxiety Disorders Program at Mount Sinai, Dr. James Murrough is a psychiatrist who organizes patient-oriented clinical research. Murrough is currently overseeing about a dozen clinical trials. The goal: identifying new treatments for depression, bipolar, anxiety and PTSD.

Who’s at risk:

The songs say that the holidays are the most wonderful time of the year, but they can also be a time of great anxiety and stress. “A lot of holiday stress is due to relational dynamics, often in the family of origin, and we know that stress is a trigger for depression,” says Dr. James Murrough, the director of the Mood and Anxiety Disorders Program at Mount Sinai. “So for people who have a history of depression, the holidays can be a particularly vulnerable time. The good news is that we do have very effective treatments for most patients.”

Most of us use the word depression pretty loosely, but psychiatrists use it to refer to Major Depressive Disorder, a medical illness. “Everybody has experienced periods of feeling, sad, down, pessimistic and anxious, which they might describe as ‘being depressed,’” Murrough says. “Major depressive disorder is a medical condition characterized by a very negative mood state, in which the individual feels sad, down or depressed, to a point where those feelings impair daily function.” About 15% of the U.S. population will experience Major Depressive Disorder in their lifetime.

The hallmarks of depression can be mental, emotional and physical. “Patients with depression feel down regardless of their environment. Something good can happen, but they can’t take joy from it like they normally would,” says Murrough. “Then there are physical symptoms, including sleep disturbances and, for some patients, an agitated, activated state.”

The risk factors of depression aren’t completely understood. “Depression is twice as common in women and we still don’t understand why, though we do know that hormones play a role,” Murrough says. “It’s estimated that up to 40% of the risk is heritable, so if you’ve had a close relative with a mood disorder or major depression, you have a higher risk.”

The negative thinking associated with depression can lead people to think that there’s nothing to be done. “The key things is that you can have depression and recover,” Murrough says. “People do very well with treatment. In the depths of it, people think nothing can help, but that’s actually a symptom of the depression.”

Signs and symptoms:

What are the red flags of depression? “Essentially, there’s an abnormal mood state that is unresponsive and negative, in some way disconnected from what’s going on around them,” Murrough says. “It represents a change from their normal state of function. It’s not who they are — and there’s functional impairment that often affects relationships and work.”

Patients often describe inability to take pleasure in their favorite things. “A patient might say, ‘I love my wife, my kids, but I’m not getting joy out of anything,’” Murrough says. “Another common complaint is, ‘I don’t want to get out of bed in the morning.’”

The depressed mood state can be accompanied by a host of changes in the body — and even cognitive impairment. “Patients report difficulty sleeping, changes in appetite or weight loss, decreased energy levels, decreased physical energy,” Murrough says. “In depressive episodes, the rational part of the brain isn’t working right and the perception of reality is skewed. People think things like, ‘I’m a bad person, everything I’ve done is wrong and it’s not going to get better.’” Along with this negative thinking and cognitive impairment comes an increased risk of suicide.

Traditional treatment:

Doctors have a range of effective options for treating depression. “We can offer medications and psychotherapy. Using either one of these, or the two together, the majority of patients with depression will get out of the episode,” Murrough says. “While there’s a risk of recurrence, we can give patients hope that with treatment they can feel better.”

It’s a cliche, but talking to someone really does help. “We’ve known for a long time that patients with depression will respond to talk therapy, whether one-on-one or in a group,” Murrough says. “One form of psychotherapy is CBT (cognitive behavioral therapy), which helps address the cognitive disorientations and boost the rational part of the brain, as well as set up action plans, schedules and calendars to shift behavior.”

The other mainstay of treatment is medication. “In many cases, medication can be used in combination with therapy,” says Murrough. “Medications can be especially helpful for patients who are in the middle of an episode, because the drugs can decrease the overdrive of the emotional parts of the brain to help them get to the point of engaging therapy.” It sometimes takes tinkering to find the right medication for the individual patient.

The holidays can dredge up a lot of difficult emotions and present taxing situations. “The bottom line is that the holidays can be stressful,” Murrough says. “When patients are in therapy, the patient and therapist will often work on identifying potential triggers when the patients returns to the family, and come up with strategies for how to respond in ways that minimize stress.”

Research breakthroughs:

One avenue of promising research involves the anesthetic agent ketamine. “Over the years, what we’ve noticed is that when some patients had an unrelated surgery, their depression would get better,” Murrough says. “Right now we’re doing trials that give patients a low dose of ketamine — and 60% of patients experience an anti-depressant effect within a few hours or days, and it lasts for days or weeks,” Murrough says. “The next question is: how could this be distributed for clinical use? It could be in the clinic within a few years.”

Questions for your doctor:

We can all benefit from asking, “What can I do to prevent depression?” If you feel you are in a depression, then ask, “What is the right treatment for me?” Two common questions are, “How long with this last?” and “Will I have to be on medication for the rest of my life?”

“If you find yourself facing the approaching holidays with dread, talk to your doctor about potential steps you can take to prevent or treat depression,” Murrough says. “The doctor and patient should always be working together in a collaborative way to find a treatment that is safe and the effective.”

What you can do:

Get informed.

There is a superb array of information online hosted by the American Psychological Association (apa.org), National Institutes of Mental Health (nimh.nih.gov/health/topics/depression/index.shtml) and Mount Sinai (mountsinai.org/patient-care/service-areas/psychiatry/areas-of-care/depression).

Exercise and eat right.

It turns out that exercise is an anti-depressant in itself. Eating a healthy diet can also help maintain a healthy mood state.

Enhance your social network.

It can be hard to find the time or energy to socialize if you’re feeling down, but it’s crucial for your mental health. “You have to find the time to nurture your relationships because they will help you,” Murrough says. “You have to find the time to pick up the phone.”

By the numbers:

– The World Health Organization has declared Major Depressive Disorder the most disabling medical condition worldwide.

– Major Depressive Disorder will affect 15% of Americans at some point in their lives.

– Genetics account for an estimated 40% of an individual’s risk of depression.

Source: Dr. James Murrough

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mental health

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